Irwin Charles E, Adams Sally H, Park M Jane, Newacheck Paul W
Department of Pediatrics, University of California, San Francisco, 3333 California St, Suite 245 San Francisco, CA 94143-0503, USA.
Pediatrics. 2009 Apr;123(4):e565-72. doi: 10.1542/peds.2008-2601.
Professional guidelines for adolescents recommend annual preventive visits with screening and anticipatory guidance for health-related behaviors. The objective of this study was to examine receipt of preventive services, including disparities in services received, by using a nationally representative sample of adolescents.
Using data from the 2001-2004 Medical Expenditure Panel Survey (ages 10-17; N = 8464), we examined receipt of preventive care visits and several measures of the content of care, based on caregiver's reports, among adolescents who received a preventive care visit during the past 12 months. Content of care outcomes included physical parameters measurement (height, weight, and blood pressure); receipt of anticipatory guidance (dental care, seat belts, helmets, exercise, healthy eating, and secondhand smoke exposure); and, for 12- to 17-year-olds, whether adolescents had time alone with their provider during their most recent visit, a proxy for confidential services. We conducted logistic regression analyses to test for disparities in the outcomes on the basis of race/ethnicity, income, and insurance status.
Thirty-eight percent of adolescents had a preventive care visit in the previous 12 months. Low-income and full-year uninsured status were associated with higher risk for not receiving this visit. Most adolescents had height (87%), weight (89%), and blood pressure (78%) assessed. Rates for height and weight were lower in poor and uninsured adolescents. Anticipatory guidance rates were much lower, ranging from 31% for seat belts, helmets, and secondhand smoke to 49% for healthy eating. Only 10% had all 6 areas addressed. Multivariate analyses yielded few disparities in receipt of anticipatory guidance. Forty percent had time alone with their providers. Hispanic and the lowest-income adolescents were the least likely to have time alone.
Few adolescents received a preventive visit; among those who received this visit, provision of recommended anticipatory guidance was very low. Strategies are required to improve delivery of recommended preventive services to adolescents.
青少年专业指南建议每年进行预防性就诊，并针对健康相关行为进行筛查和预期指导。本研究的目的是通过使用具有全国代表性的青少年样本，来检查预防性服务的接受情况，包括所接受服务方面的差异。
利用2001 - 2004年医疗支出小组调查的数据（年龄10 - 17岁；N = 8464），我们根据照顾者的报告，检查了在过去12个月接受过预防性就诊的青少年中预防性保健就诊的接受情况以及护理内容的若干衡量指标。护理内容结果包括身体参数测量（身高、体重和血压）；预期指导的接受情况（牙齿护理、安全带、头盔、运动、健康饮食和二手烟暴露）；对于12至17岁的青少年，是他们在最近一次就诊时是否有单独与提供者相处的时间，这是获得保密服务的一个指标。我们进行了逻辑回归分析，以检验基于种族/族裔、收入和保险状况的结果差异。
38%的青少年在过去12个月内进行了预防性保健就诊。低收入和全年无保险状况与未进行此次就诊的较高风险相关。大多数青少年的身高（87%）、体重（89%）和血压（78%）得到了评估。贫困和无保险青少年的身高和体重评估率较低。预期指导率要低得多，从安全带、头盔和二手烟的31%到健康饮食的49%不等。只有10%的人涉及了所有6个领域。多变量分析显示在接受预期指导方面差异不大。40%的人有单独与提供者相处的时间。西班牙裔和收入最低的青少年最不可能有单独相处的时间。
很少有青少年接受预防性就诊；在接受就诊的青少年中，推荐的预期指导的提供率非常低。需要采取策略来改善向青少年提供推荐的预防性服务的情况。
